Key Messages Derived From Literature Review of Antiepileptic Drugs (AED) Treatment for Bipolar Disorder

  1. No scientifically acceptable clinical trial evidence supports use of either gabapentin or topiramate in bipolar mood disorder, either as monotherapy or as an adjunct to other therapies.
    For the reasoning behind this message, see key concept #8.
  2. Research supports use of three antiepileptic drugs—(1) carbamazepine, (2) valproic acid/valproate and (3) lamotrigine in achieving and maintaining remission for outpatient adults with primary diagnoses of bipolar I disorder. Evidence of efficacy is less clear for these treatments for type II bipolar disorder. Only limited evidence supports the efficacy of carbamazepine for maintaining remission in bipolar I disorder.  Lamotrigine is not effective in achieving remission in acute mania/mixed episodes.
    For the reasoning behind this message, see key concepts #1-4.
  3. Carbamazepine, valproic acid/valproate, and lamotrigine work as well as lithium in achieving and maintaining remission in bipolar I disorder.
    For the reasoning behind this message, see key concept #5.
  4. Types of adverse events vary among anti-epileptic drugs and lithium. There is insufficient evidence to determine if the overall risk of adverse events differs among AEDs. Unlike the AEDs, lithium poses significant risk when taken in an overdose.
    For the reasoning behind this message, see key concepts #6-7.


The latest search for peer-reviewed literature concerning these key messages: Sept 25, 2008